Clinical Question

Does the use of GlideScope video laryngoscopy affect survival to hospital discharge in adult patients requiring emergency airway management?

Conclusion

No mortality benefit was found with the use of GlideScope vs Direct Laryngoscopy(DL) in trauma patient intubation. Use of the GlideScope in patients with severe head injury had a greater incidence of hypoxia and mortality on subgroup analysis.

Interventions

All patients received RSI with either thiopental or etomidate and succinlcholine followed by preoxygenation and inline cervical spine immobilization. Intubation was performed by an attending anesthesiologist or a EM or anesthesia resident with 1 year intubating experience. All intubations were recorded on video with digital capture of vital signs every 6 seconds. Time to intubation was defined as difference between mouth insertion of blade and removal with confirmation via continuous capnography and physical exam. Multiple attempts were added together for cumulative time.

Outcome

Primary Outcomes

Mortality rate: 7.5% (DL) vs 9.2% (GlideScope)

p = 0.43

Secondary Outcomes

First-pass Success: 81% (DL) vs. 80%(GlideScope)

p=0.46

Subgroup analysis

Intubation Duration(seconds): 40 (DL) vs. 56 (GlideScope)

Mortality in Head Injury: 16% (DL) vs 22% (GlideScope)

Criticisms

Although patients were randomized, the attending physician could choose to remove a patient from the study due to preference for DL or GlideScope. 210 of 898 eligible patients were excluded for this reason. Also, this study only uses the GlideScope video laryngoscope with the hyper-angulated blade, so abstraction to all videolaryngoscopy is not possible.